Document Detail


Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion: a pilot trial in the prevention of contrast nephropathy.
MedLine Citation:
PMID:  12040355     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Radiocontrast nephropathy (RCN) is a common source of acute renal failure in hospitalized patients and is associated with increased morbidity and mortality rates. Fenoldopam mesylate is a dopamine A1 receptor agonist that augments renal plasma flow (RPF) in patients with normotensive and hypertensive conditions. To determine whether fenoldopam mesylate attenuates reductions in RPF after contrast infusion, we conducted a double-blind, randomized, placebo-controlled pilot trial of fenoldopam mesylate in patients who underwent contrast angiography. METHODS: Fifty-one patients with chronic renal insufficiency (creatinine level, 2.0-5.0 mg/dL) who were undergoing contrast angiography were screened, and 45 patients were randomized to receive normal saline solution (1/2 NS) or 1/2 NS plus fenoldopam mesylate at 0.1 microg/kg/min at lease 1 hour before infusion with contrast dye. Serum creatinine level was measured at baseline and at 24, 48, and 72 hours after angiography. The primary endpoint was change in RPF 1 hour after contrast infusion. The secondary endpoint was incidence of RCN, defined as a 0.5 mg/dL or a 25% rise in serum creatinine level at 48 hours. RESULTS: RPF at 1 hour after angiography was 15.8% above baseline in the fenoldopam mesylate group compared with 33.2% below baseline in the 1/2 NS group (P <.05). The incidence rate of RCN at 48 hours was 41.0% in the 1/2 NS group versus 21% in the fenoldopam mesylate group (P =.148). Among patients with diabetes, the incidence rate of RCN tended to be higher in the 1/2 NS group compared with the fenoldopam mesylate group (64% vs 33%; P =.14). The peak serum creatinine level at 72 hours after contrast infusion was significantly higher at in the 1/2 NS group (creatinine level, 3.6 +/- 1.0 mg/dL) compared with the fenoldopam mesylate group (creatinine level, 2.8 +/- 0.35 mg/dL; P <.05). RPF was significantly (P <.0001) reduced in patients with RCN compared with patients in whom RCN did not develop. CONCLUSION: The results of this pilot trial suggest that fenoldopam mesylate is a promising prophylactic agent for RCN and that larger multicenter trials should be conducted to prove its efficacy.
Authors:
J A Tumlin; A Wang; P T Murray; V S Mathur
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American heart journal     Volume:  143     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-05-31     Completed Date:  2002-06-10     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  894-903     Citation Subset:  AIM; IM    
Affiliation:
Emory University School of Medicine, Atlanta, GA 30322, USA. JTUMLIN@emory.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Contrast Media / adverse effects*
Double-Blind Method
Female
Fenoldopam / therapeutic use*
Humans
Kidney / blood supply,  drug effects*
Kidney Failure, Acute / chemically induced,  prevention & control*
Male
Pilot Projects
Prospective Studies
Vasodilator Agents / therapeutic use*
p-Aminohippuric Acid / adverse effects,  diagnostic use*
Grant Support
ID/Acronym/Agency:
R01HL59978-01A1/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Vasodilator Agents; 61-78-9/p-Aminohippuric Acid; 67227-56-9/Fenoldopam

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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